MEDICARE: DR. ANGELA M. HENDERSON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CHIR006198	GA

General Provider Information

NPI Number	:	1245311364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA M. HENDERSON D.C.

Provider Business Mailing Address
First Line	:	218 WHITESTONE DR
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-4189
Country	:	US
Telephone Number	:	770-720-8346
Fax Number	:

Provider Business Practice Location Address
First Line	:	4992 OLD HWY #5
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188
Country	:	US
Telephone Number	:	770-592-1986
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	06/24/2026

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